Local ambulance companies join effort to transform EMS system

Local ambulance companies join effort to transform EMS systemSeveral ambulance companies in the state, including local providers South Shore Hospital EMS and Fallon Ambulance of Quincy, are trying to transform the state's EMS system by proposing pilot programs that, if approved by the state's Department of Public Health, ...

QUINCY – If you get treated by a paramedic today, you’ll get in an ambulance and be sent to an emergency room. There’s no getting around it unless you refuse to be transported – it’s the law.

But several ambulance companies in the state, including local service providers South Shore Hospital EMS and Fallon Ambulance of Quincy, are trying to transform this practice by proposing plans that would allow paramedics to start treating patients at their homes with no automatic trip to the ER.

Proponents of the new practice, which needs approval from the state Department of Public Health, say reducing the number of unnecessary trips to the hospital would lower inflated health care costs and improve patient care.

“It really changes the complete dynamic of the emergency medical services mind set, which has been: you call 911, we pick you up and we bring you to the hospital,” said Dr. Jason Tracy, chairman of emergency medicine at South Shore Hospital in Weymouth. “This really challenges that thinking.”

Although it hasn’t debuted in Massachusetts, this practice of paramedics giving at-home care in lieu of transportation, also being called community paramedicine or mobile integrated health care, has gained popularity in other states. Many in the industry say MedStar Mobile Healthcare of Fort Worth, Texas, is the trailblazer, providing a successful model that other ambulance companies have adopted.

Proponents of mobile integrated health care say it particularly benefits patients who make frequent trips to the emergency room, like those with pulmonary disease who are prone to shortness of breath and elderly people susceptible to falls. Superfluous trips to the hospital crowd waiting rooms while raising health care costs for providers and patients alike, experts say.

Patrick Tyler, executive vice president of Fallon Ambulance, which provides 911 services in Quincy, Weymouth, Braintree and Milton, said his company plans to launch two initiatives this summer – a fall-risk program, in which paramedics can give at-home treatment to prevent future falls, and a more general program in which paramedics provide first-response treatment and referrals that don’t automatically result in a trip to the hospital.

Tyler said mobile integrated health care doesn’t mean paramedics must provide all the treatment on-site. The paramedic, he said, could transport a patient to a nursing facility, urgent-care center, physician’s office or, if needed, a hospital.

“Aligning you with the right care – that’s what it really comes down to,” Tyler said.

As an example, he said someone who badly twists an ankle may not need hospital treatment but would benefit from a direct trip to a specialist’s office. Tyler estimated the patient’s cost difference: about $4,000 for the hospital visit compared to $900 for the specialist.

Page 2 of 3 - Tyler said the introduction of mobile integrated health care in Massachusetts is a byproduct of the Affordable Care Act, or Obamacare, which provides incentives for lowering health care costs.

Tyler emphasized that the new practice isn’t meant to replace other more traditional forms of at-home treatment, like those services provided by licensed visiting nurses.

Pat Kelleher, executive director of the HomeCare Alliance of Massachusetts, was more skeptical. Although she said she fully supports any effort to reduce unneeded hospital visits, she said most forms of non-emergency, long-term patient care should be left to the professionals trained for home care, like nurses or behavioral therapists.

“Short-term stability is one thing, but often these patients need a mix of services for complex issues. I can’t imagine a paramedic or EMT receiving enough additional training that could replace these roles,” Kelleher said.

Eugene Duffy, an EMT-paramedic and manager of South Shore Hospital EMS, said his paramedics would undergo a significant amount of new training before practicing community paramedicine. He said not all paramedics are interested in pursuing it because they’re more comfortable with shorter stays with patients.

“It’s a particular personality type that would want to do this job,” Duffy said. “Some would flourish in that position. Some would want to continue transporting patients in emergencies.”

Supporters of the new practice say there’s one major problem with it: a lack of funding. As of now, the state’s health insurance companies and the government-run programs, Medicare and Medicaid, won’t pay for EMS services that don’t involve transportation. Also, patients can’t be billed by EMS companies that don’t provide transportation.

Until the insurance companies come on board, it’s up to the ambulance companies to fund their own pilot programs.

“Out of the gate, the issue is building a sustainable program,” Tyler said. “Who is going to pay for it? Right now, it’s left to our devices within the company.”

Tyler, who serves as the chairman of the Metropolitan Boston Emergency Medical Service Council, said three ambulance companies – Boston EMS, Cataldo Ambulance Service on the North Shore and EasCare EMS – are in the first wave of mobile-integrated health care programs that have been proposed to the state. South Shore Hospital EMS and Fallon are among the companies looking to get approval next.

Tyler said Boston EMS is considering a fall-prevention program, Cataldo is partnering with Beth Israel Deaconess Hospital to provide follow-up care after a hospital discharge, and EasCare of Dorchester is partnering with the nonprofit Commonwealth Care Alliance to service its Medicare and Medicaid patients in Boston and South Shore communities.

Page 3 of 3 - Each plan needs to be granted a project waiver from the state because the practice varies from current law, which says EMS treatment must include transportation to a hospital.

As of Friday, no companies had been approved to practice mobile integrated health care, state Department of Public Health spokesman David Kibbe said.

Patrick Ronan may be reached at pronan@ledger.com. Follow him on Twitter @PRonan_Ledger.